Messier v. Southbury Training School

Decision Date05 June 2008
Docket NumberNo. 3:94-CV-1706 (EBB).,3:94-CV-1706 (EBB).
CourtU.S. District Court — District of Connecticut
PartiesRichard MESSIER, et al., Plaintiffs, v. SOUTHBURY TRAINING SCHOOL, et al., Defendants.

David C. Shaw, Law Offices of David C. Shaw, Bloomfield, CT, Frank J. Laski, Mental Health Legal Advisors Committee, Boston, MA, Barbara E. Ransom, Judith A. Gran, Philadelphia, PA, for Plaintiffs.

Henry A. Salton, Hugh Barber, Richard J. Lynch, Marianne Horn, Attorney General's Office, Health & Human Services, Hartford, CT, for Defendants.

MEMORANDUM OF DECISION AND ORDER

ELLEN BREE BURNS, Senior District Judge.

This class action challenging the defendants' administration of Southbury Training School ("STS"), an institution for the mentally disabled in the State of Connecticut, was brought in 1994 by residents of STS and by three advocacy organizations. The plaintiffs, who seek solely injunctive relief, allege constitutional and statutory violations relating to the conditions, services and programs at STS. On January 25, 1999, a 123-day bench trial was commenced before the court. The case is now ready for decision.

BACKGROUND

On July 8, 1996, pursuant to Federal Rule of Civil Procedure 23(b), the court certified the plaintiff class to include all current STS residents, persons who might be placed at STS in the future, and persons who were transferred from STS but remain under the control of the STS Director. As of the date of the trial in this case, the plaintiff class included approximately 700 residents of STS.1 The defendants in this case are STS itself, the Director of STS, and the Commissioner of the Connecticut Department of Mental Retardation ("DMR").2

First, the plaintiffs claim that STS and DMR violated the class members' substantive due process rights by (1) failing to provide adequate shelter, clothing, nutrition, and medical care; (2) failing to provide adequate habilitation and training services to class members such that class members could retain self-care skills and remain free from the unnecessary use of restraints; (3) failing to provide safe conditions to class members and to protect them from bodily harm; and (4) failing to exercise professional judgment in making decisions about whether or not to place class members in the community rather than at STS. (Third Am. Compl. ¶¶ 48-64, 69-75, 83, 86(a)-(I).)

Second, the plaintiffs claim that the defendants violated Title II of the Americans with Disabilities Act of 1990 ("ADA" or "Title II"), 42 U.S.C. § 12132 (1997), and Section 504 of the Rehabilitation Act of 1973 ("Section 504"), 29 U.S.C. § 794 (1997), by failing to place class members in community-based residential settings. The plaintiffs claim that the defendants violated these statutes in two different ways. The plaintiffs first claim that STS and DMR violated the "integration mandates" of the ADA and Section 504 by failing to make sufficient efforts to place class members into integrated settings in the community. (Id. ¶ 87.) The plaintiffs' second claim under the ADA and Section 504 is that the defendants discriminated on the basis of the severity of class members' disabilities by failing to consider community placement for certain profoundly and severely retarded STS residents. (Id. ¶¶ 81, 83, 87.)

Third, the plaintiffs seek relief pursuant to 42 U.S.C. § 1983 for violations of Title XIX of the Social Security Act ("Title XIX"), codified at 42 U.S.C. § 1396a et seq., which governs the certification that is required by an intermediate care facility for the mentally retarded ("ICF/MR") in order to receive certain federal funding. The plaintiffs claim that the defendant Commissioner of DMR violated Title XIX by failing to provide some class members with "active treatment" as required by § 42 U.S.C. § 1396d(d), as well as by failing to provide medical and other services consistent with that statute. (Third Am. Compl. ¶ 88.)

Many of the instances of inadequate medical care, security and habilitation programming at STS have been the subject of a related case, United States v. Connecticut, No. 3:86-cv-252 (D.Conn.1986), which was, until recently, pending before this court. The United States v. Connecticut litigation was initiated in 1986, when the United States Department of Justice brought suit against the State of Connecticut seeking to remedy allegedly unconstitutional conditions at STS. Later in 1986, a consent decree was negotiated by the parties and was approved by the court. The court approved additional consent decrees in 1990 and 1991. In 1993, attorneys from the Department of Justice, along with a team of experts, investigated conditions at STS and concluded that the defendants had failed to comply with the consent decrees. See United States v. Connecticut, 931 F.Supp. 974, 975-76 (D.Conn.1996).

After conducting a hearing, the court found by clear and convincing evidence that defendants had not complied with the terms of the consent decree and held them in contempt. Id. The contempt hearing revealed numerous deficiencies in the conditions at STS and the services and programs provided to its residents. The court found that "STS's systemic flaws [had] caused many residents to suffer grave harm, and, in several instances, death." Id. at 983-84. The court found that STS provided inadequate medical care to its residents. Id. at 980. The court found that STS had failed to implement the habilitation programs needed to train residents to avoid injury. Id. at 977-78. The court found that STS administered behavior modifying medication in cases where the institution should have provided habilitation. Id. at 979-80. The court found that physical therapy services as STS were so inadequate as to have caused "several residents who, only a few years earlier, were ambulatory, to be permanently bed-ridden." Id. at 983.

In United States v. Connecticut, as the plaintiffs here were aware, the court appointed a Special Master to review many aspects of care and treatment at STS and to work with the parties in implementing changes to STS's operations. Id. at 985. Following his appointment in 1997, Special Master David Ferleger and the parties created a comprehensive Remedial Plan that specified certain objectives upon which the parties had agreed. Remedial Plan, U.S. v. Conn. (April 1, 1998).3 The Remedial Plan set forth 95 Court Requirements ("CR"), thus establishing standards that the institution would be required to meet in order to purge itself of contempt. These Court Requirements covered most areas of STS's operations including staffing, quality assessment procedures, medical treatment, administration of medication, habilitation programming, and case management.

In a process of evaluation lasting almost a decade, the Special Master, with the assistance of experts commissioned by him and the parties, measured improvements at STS against the standards set forth in the Court Requirements. Periodically when the Special Master concluded that the defendants had demonstrated compliance with a particular Court Requirement, he recommended that the court release STS from oversight for that Court Requirement. Finally, in 2006, after the Special Master found STS to be in compliance with all remaining requirements of the Remedial Plan, the court released STS from judicial oversight and purged the defendants of contempt. See Order Purging Defendants of Contempt and Ending Active Judicial Oversight, U.S. v. Conn., (Mar. 24, 2006).

DISCUSSION AND FINDINGS
I. The Due Process Requirements for Programs and Services at State-Run Institutions

Residents of state-operated institutions for the mentally retarded "have a constitutional right to adequate food, shelter, clothing and medical care." Society for Good Will to Retarded Children, Inc. v. Cuomo, 737 F.2d 1239, 1243 (2d Cir.1984) (citing Youngberg v. Romeo, 457 U.S. 307, 316, 102 S.Ct. 2452, 73 L.Ed.2d 28 (1982), and Estelle v. Gamble, 429 U.S. 97, 97 S.Ct. 285, 50 L.Ed.2d 251 (1976)). Residents also have a constitutionally protected interest in safe conditions and in freedom from bodily restraint except to the extent that restraint must be used to assure safety. Youngberg, 457 U.S. at 315-16, 323, 102 S.Ct. 2452; see also Society for Good Will, 737 F.2d at 1245. Due process also requires that an institution provide its residents with a minimal level of training, or "habilitation."4 Youngberg, 457 U.S. at 324, 102 S.Ct. 2452.

These constitutional requirements are satisfied when state actors have exercised "professional judgment" in determining what services and care should be provided to residents of state-run institutions. Youngberg, 457 U.S. at 321-22, 102 S.Ct. 2452. This standard, which is highly deferential to the decisions of the state's professionals, is intended to strike a balance between the "liberty interest of the individual" and the "legitimate interests of the State, including the fiscal and administrative burdens additional procedures would entail." Id. at 321, 102 S.Ct. 2452 (citing Parham v. J.R., 442 U.S. 584, 599-600, 99 S.Ct. 2493, 61 L.Ed.2d 101 (1979)). Under this standard, a "decision, if made by a professional, is presumptively valid." Id. at 323, 102 S.Ct. 2452.

Plaintiffs may demonstrate a violation of the requirement that the state exercise professional judgment in at least two ways. Plaintiffs will prevail, for example, when state actors "simply failed to exercise any professional judgment." See, e.g., Valentine v. Strange, 597 F.Supp. 1316, 1318 (D.C.Va.1984) (declining to dismiss complaint by patient who set fire to herself after hospital officials took no action to confiscate her cigarettes, and lighter despite the fact that she had unsuccessfully attempted to burn herself earlier in the day). Deference under Youngberg is not owed to decisions made by individuals who are not qualified professionals. See, e.g., Cameron v. Tomes, 783 F.Supp. 1511, 1520-21 (D.Mass.1992) (fin...

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